Pope Marita Knudsen, Chugh Harpriya, Sargsyan Arayik, Uy-Evanado Audrey, Salvucci Angelo, Jui Jonathan, Reinier Kyndaron, Chugh Sumeet S
Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Cardiology, Oslo University Hospital, Ullevaal, and the Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Heart Rhythm. 2025 Aug;22(8):1984-1993. doi: 10.1016/j.hrthm.2025.05.013. Epub 2025 May 12.
Risk stratification for sudden cardiac death (SCD) in heart failure (HF) patients is largely based on left ventricular ejection fraction (LVEF) of ≤35%. However, disease-related LV remodeling and medical treatment may change LVEF over time.
This study aimed to evaluate the temporal trends in LVEF in patients with HF who experience an SCD.
We performed 2 retrospective cohort studies (discovery and validation) of patients who experienced SCD after an established diagnosis of HF. Individuals were identified from 2 separate population-based studies of SCD in Oregon and California, if they underwent ≥2 echocardiographic evaluations performed at least 6 months apart.
The Oregon discovery cohort included 526 patients (male 63.9%; age 70.4 [13.2]), and the California validation cohort 191 patients (male 60.7%; age 74.6 [13.6]). In the discovery cohort, 45% of patients with LVEF of ≤35% on first assessment were reclassified to LVEF of >35% at final assessment (P < .001). Among patients with LVEF of 36%-49%, 66% were reclassified to either ≤35% or >50% (P < .001). In patients with LVEF of >50%, 32% were reclassified to LVEF of <50% (P < .001). Overall, 41.1% of patients in the discovery cohort were reclassified based on LVEF (P < .001). No distinguishing characteristics were identified between patients with an initial LVEF of ≤35% who improved or did not. Similar findings were observed in the validation cohort.
LVEF category changed significantly over time, resulting in substantial reclassification of risk before the SCD event. These findings highlight the major limitation of using LVEF measured at a single time point as the main predictor of SCD risk.
心力衰竭（HF）患者心源性猝死（SCD）的风险分层主要基于左心室射血分数（LVEF）≤35%。然而，疾病相关的左心室重构和药物治疗可能会随时间改变LVEF。
本研究旨在评估发生SCD的HF患者LVEF的时间趋势。
我们对确诊HF后发生SCD的患者进行了两项回顾性队列研究（发现队列和验证队列）。如果个体接受了至少间隔6个月的≥2次超声心动图评估，则从俄勒冈州和加利福尼亚州两项基于人群的SCD独立研究中进行识别。
俄勒冈州发现队列包括526例患者（男性63.9%；年龄70.4[13.2]），加利福尼亚州验证队列191例患者（男性60.7%；年龄74.6[13.6]）。在发现队列中，首次评估时LVEF≤35%的患者中有45%在最终评估时重新分类为LVEF>35%（P<.001）。在LVEF为%的患者中，66%重新分类为≤35%或>50%（P<.001）。在LVEF>50%的患者中，32%重新分类为LVEF<50%（P<.001）。总体而言，发现队列中41.1%的患者基于LVEF进行了重新分类（P<.001）。初始LVEF≤35%且病情改善或未改善的患者之间未发现明显特征差异。在验证队列中也观察到了类似的结果。
LVEF类别随时间发生显著变化，导致SCD事件前风险的大量重新分类。这些发现突出了将单次测量的LVEF用作SCD风险主要预测指标的主要局限性。 （注：原文中“在LVEF为%的患者中”这里有信息缺失，翻译时保留了原文格式）
